Life Insurance And Medicare: Can You Have Both?

Medicare is a federal health insurance program for people aged 65 or older, people with certain disabilities, and people with End-Stage Renal Disease. While Medicare benefits do not have an expiry date, there are certain circumstances in which a person may lose their Medicare coverage. For example, if an individual moves out of the country, their Medicare coverage will no longer be valid. Similarly, if a person is incarcerated and in federal prison, their benefits will stop, but will resume upon their release. Additionally, Medicare coverage may be discontinued if an individual fails to pay their premiums.

Medicare coverage for those over 65 years old

Medicare is generally available to people aged 65 or older in the US. However, there are other ways to qualify for Medicare besides age. For example, those with certain disabilities, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (Lou Gehrig's disease) may also be eligible.

Medicare coverage for those over 65 starts when you sign up and depends on which sign-up period you're in. Generally, your first chance to sign up is during your Initial Enrollment Period, which lasts for 7 months, starting 3 months before you turn 65 and ending 3 months after. If you miss this period, you may have to pay a monthly late enrollment penalty.

If you don't have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 or anytime after. If you have health insurance from an employer, you may be able to wait to sign up for Medicare without paying a late enrollment penalty. Once you stop working or lose your health insurance, you have an 8-month Special Enrollment Period (SEP) to sign up for Medicare or add Part B to existing Part A coverage.

If you have retiree coverage from a previous job, it may not pay for your health services if you don't have both Medicare Part A and Part B. It's important to check with your benefits administrator to see how your retiree coverage works with Medicare.

Medicare has four parts: Part A (Hospital Insurance), Part B (Medicare Insurance), Part C (Medicare Advantage Plans), and Part D (Drug Coverage). Most people don't pay a premium for Part A coverage, but you will have to pay a premium for Part B coverage every month, even if you don't use any of the services. Monthly premiums for Part C and Part D coverage vary based on the plan you join.

Losing Medicare coverage due to non-payment of premiums

Life insurance and Medicare are two different things, and having one does not mean you will lose the other. However, there are certain circumstances in which you can lose your Medicare coverage. One of these is non-payment of premiums.

Medicare coverage can be discontinued if you do not pay your premiums. However, this will not happen without warning. You will be given a grace period to make the payment, and you will receive a delinquency notice before your coverage is dropped. The length of the grace period depends on the type of Medicare plan. For Medicare Part B, you will have three months to pay an initial bill. If you do not pay by the end of the grace period, you will receive a termination notice. If you pay what you owe within 30 days of the termination notice, your coverage will continue. If not, your coverage will be discontinued, and you will need to re-enroll during the general Medicare enrollment period (January 1 to March 31).

For Medicare Parts C and D, the grace period is at least two months, and some plans have a longer grace period. If you do not pay by the end of the grace period, you risk disenrollment from your plan. In some cases, you may be given the option to contact your plan administrator if you are behind on payments due to financial difficulties. If you are disenrolled from your Part D plan, you will have the option to re-enroll during the Annual Election Period (October 15 to December 7). If you are disenrolled from Medicare Advantage, you will be automatically enrolled in Original Medicare, but you may lose drug coverage. You can then enroll in Medicare Advantage again during the Annual Election Period.

Ways to Pay Your Medicare Premium

To avoid losing your Medicare coverage due to non-payment of premiums, you can set up automatic payments from your checking account or credit card. Alternatively, you can pay your premium through your Medicare account, by mail, or through your bank's online bill payment service.

Medicare coverage for those with a disability

Medicare is a federal health insurance program for people aged 65 and older, as well as some disabled people under 65, and people with End-Stage Renal Disease (ESRD). According to the Social Security Administration (SSA), everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. Generally, a disability that gives Medicare eligibility must be "severe" and is defined by the SSA as:

> "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."

Mental disorders such as schizophrenia and bipolar disorder, endocrine disorders such as diabetes mellitus, and cancer may qualify someone for disability and, therefore, Medicare eligibility.

Certain health conditions, such as ESRD or Lou Gehrig's disease (ALS), may also qualify someone for Medicare without the 24-month waiting period. Starting in 2023, if someone has ESRD, they are generally also eligible for a Medicare Advantage plan.

People with disabilities who are under 65 and qualify for Medicare must have received SSDI benefits for 24 months or have ESRD or ALS. There is a five-month waiting period after a beneficiary is deemed disabled before they begin to collect SSDI benefits. People with ESRD and ALS do not have to collect benefits for 24 months to be eligible for Medicare.

The requirements for Medicare eligibility for people with ESRD and ALS are:

• ESRD: Generally, 3 months after a course of regular dialysis begins or after a kidney transplant.
• ALS: Immediately upon collecting SSDI benefits.

People who meet the criteria for SSDI are automatically enrolled in Parts A and B of Medicare. Those who meet the standards but do not qualify for SSDI benefits can purchase Medicare by paying a monthly Part A premium, in addition to the monthly Part B premium. Part A is hospital insurance, while Part B is medical insurance. Most people pay monthly for Part B.

Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. The full range of Medicare benefits are available, including certain hospital, nursing home, home health, physician, and community-based services. The healthcare services do not have to be related to the individual's disability to be covered. There are no illnesses or underlying conditions that disqualify people for Medicare coverage.

Medicare eligibility for working people with disabilities falls into three distinct time frames: the trial work period, the seven-and-three-quarter years (93 months) after the trial work period, and an indefinite period following those 93 months. During the trial work period, an individual who is receiving SSDI benefits is entitled to continue receiving Medicare and SSDI income for a maximum of 9 months during any rolling 5-year time period. To qualify, an individual must meet a monthly gross earnings threshold or work more than 80 hours of self-employment per month.

After the trial work period, individuals who still have a disabling impairment but have earned income that meets or exceeds the "Substantial Gainful Activity" level can continue to receive Medicare health insurance. This new period of eligibility can last for up to 93 months after the trial work period, for a total of eight-and-a-half years, including the trial work period. During this time, SSDI cash benefits may cease, but the beneficiary pays no premium for the hospital insurance portion of Medicare (Part A). Premiums are due for the supplemental medical insurance portion (Part B).

Even after the eight-and-a-half-year period of extended Medicare coverage, working individuals with disabilities can continue to receive benefits as long as they remain medically disabled and are under 65. At this point, they will have to pay the premium for Part A as well as Part B. The amount of the Part A premium depends on the number of quarters of work in which the individual or their spouse has paid into Social Security.

Losing Medicare coverage for those with permanent kidney failure

Medicare coverage for individuals with permanent kidney failure, also known as end-stage renal disease (ESRD), is available regardless of age. This condition is one of only two that allow individuals to enrol in Medicare without a two-year waiting period.

For those who are eligible for Medicare based on age (65 or older) or have received Social Security Disability for 24 months, the following does not apply.

People who need dialysis are not eligible to sign up for Medicare (Parts A and B) until the day they begin dialysis. Once they sign up, Medicare will be effective at the beginning of their fourth month of dialysis and will start paying for their treatment if they choose in-centre haemodialysis. For those who start dialysis at home, Medicare coverage is effective on their first day of dialysis treatment.

Medicare also covers kidney transplants. After someone receives a successful kidney transplant, Medicare will continue to cover medical expenses for three years. If someone has health insurance through their employer or their spouse's employer, that insurance plan will be primary for 30 months starting the day their dialysis begins. After that, Medicare pays first, and their employer health plan will pay second.

If an individual has Medicare coverage only because of permanent kidney failure, their coverage will end 12 months after the month they stop dialysis treatments or 36 months after the month they have a successful kidney transplant.

If an individual starts dialysis or gets another kidney transplant within 12 months of stopping dialysis or within 36 months of their first transplant, their Medicare coverage will resume.

Losing Medicare coverage due to moving outside the plan's coverage area

If you are moving and have Medicare coverage, you may qualify for a Special Enrollment Period (SEP) to make changes to your plan. The type of coverage you have will determine if you need to make changes after moving.

If you are enrolled in Original Medicare (Part A and Part B), you don't need to make any changes to your coverage when moving to a new address, even if it is out of state. Original Medicare is an insurance policy that can be used countrywide and is accepted by any hospital or doctor throughout the country that takes Medicare assignment.

However, if you are enrolled in a Medicare Advantage plan or Medicare Part D (prescription drug plan), you will need to enroll in a plan that is within your new service area if you are moving outside your plan's service area. This is because Medicare Advantage and Part D plans have geographic boundaries. If you move to a new city that is outside of your plan's network, you will lose your Medicare Advantage or Part D plan. In this case, you will either have to enroll in a new plan or opt to return to Original Medicare and also enroll in a Part D plan.

If you are moving out of state, your Medigap (Medicare Supplement Insurance) coverage will generally still be valid, although some rules and regulations may differ. Medigap policies are standardized by the federal government, which means that Plan A, for example, will have the same benefits no matter where you live in the U.S. However, the premium you pay for your Medigap policy may differ from state to state. Additionally, some states have open enrollment periods for Medigap, while others have limited enrollment periods. Therefore, it is important to research the rules and regulations for Medigap coverage in your new state of residence. In some cases, your insurance company may not offer your Medigap policy in your new state of residence, and you may have to find a new insurance company.

If you are moving, it is important to notify Medicare of your new address as soon as possible. This is because your address is used to determine the cost of your Part B premium, and your new address may affect your Medicare Advantage or Part D prescription drug coverage. You can update your address by calling Medicare or logging into your "My Medicare" account on the Medicare website. If you have Medicare Advantage, you will need to contact your plan directly to update your address information.

Frequently asked questions